Common signs of a stroke, such as facial weakness and slurred speech, can be alarming and reason for an ambulance to the emergency room, especially for older or susceptible individuals. However, some of these symptoms may be confused with Bell’s palsy, and for good reason. To illustrate, Bell’s palsy tends to be characterized by facial weakness and drooping of the lips, which overlap with many common stroke symptoms. However, the similarities end here as Bell’s palsy is a temporary and benign condition since it only affects a facial nerve while strokes are serious medical emergencies that are caused by damage to brain tissue usually due to a blood clot or ruptured blood vessel. Thus, without further examination, these two conditions initially appear to be very similar, which emphasizes the necessity of thorough and accurate medical practices to determine the condition and best course of treatment. From my shadowing experience, physicians tend to order MRI or CT scans to observe if any brain infarctions, or tissue damage, has occurred since physical examinations may not be conclusive. Furthering this notion, even though Bell’s palsy should not affect speech and cause aphasia, slurred speech may not be conclusive since some patients may naturally speak in a slightly slurred manner. Overall, rigorous testing should be conducted for each case before a decisive diagnosis is made.
Such was the case for a 66-year-old woman who presented to the emergency department with weakness on one side of her face, recent nausea, and slightly slurred speech. After general exams and blood labs were run, her blood clotting results appeared normal, and her CT scans showed no abnormalities. Even after MRI scans were performed for further analysis, no obvious clot or hemorrhage could be detected. Despite these findings, the patient’s hypertension and physical state upon arrival made the possibility of a stroke much more likely than Bell’s palsy. As a result, the scans were re-evaluated by a neuroradiologist who noticed very small tissue damage near the pons, or brainstem. After a follow-up review with the stroke clinic, the patient suffered no permanent injuries and was prescribed stroke prevention medication. As such, it is crucial for healthcare professionals to continue being meticulous and open-minded when diagnosing patients, especially since many conditions can manifest themselves in a myriad of ways with varying causes.
It's super important to be open minded when diagnosing a patient. Every new patient needs to come with a new perspective. While working in the ED many patients would have a stroke screen evaluation where the physician would meet the patient, see their vitals, and check for any deficits (weakness in their arms, legs, and equal bilateral sensation to touch). There was this one time where I had this patient, 44m, who came with extremely slurred speech and weakness on one side of the body. Once I saw the patient I called over a physician who did their initial evaluation and called the code stroke. Per protocol a 12 lead-EKG, CT, drawing of a rainbow set, and glucose were checked. Upon checking the patient's glucose the glucometer showed "Hi". I informed the physician who told me to bring the patient back to the room asap. The patient's CT and EKG were unremarkable and upon the physician putting the patient on an insulin drip the patient's symptoms subsided. There are many illness that present themselves as a stroke, but by completing protocols one is able to give the appropriate diagnosis.
ReplyDeleteThis post brings up a very important point, which all current and future healthcare professionals should take to heart. Symptoms can always fit many diseases, however it is essential to make correct diagnoses. Misdiagnoses can lead to detrimental outcomes for the patient.
ReplyDeleteWas this patient previously diagnosed with Bell's palsy, or was it a possible diagnosis due to the lack of stroke evidence?
How does stroke medication work? What pathways does it follow to decrease stroke risk?
This reminds me of my anatomy class in which I've learned that there's a variation in anatomy from person to person and this relates to variation in symptoms shown from person to person. A commonality in both of these is misdiagnosis. A misdiagnosis can have a huge impact on patients as we've seen/heard of happening. This goes to show the importance in understanding and teaching that diseases or conditions can present themselves in many ways.
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